Provider Demographics
NPI:1689708596
Name:PETERS, PAUL GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GREGORY
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2587 COMMONS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3841
Mailing Address - Country:US
Mailing Address - Phone:937-836-3118
Mailing Address - Fax:937-832-5588
Practice Address - Street 1:2587 COMMONS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3841
Practice Address - Country:US
Practice Address - Phone:937-836-3118
Practice Address - Fax:937-832-5588
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0069815207XX0004X
OH35.094078207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery